• Journal of Korean Neurosurgical Society
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• v.63 no.3
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• pp.279-313
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• 2020

This review summarises the classification, anatomy and embryogenesis of complex spinal cord lipomas, and describes in some detail the new technique of total lipoma resection and radical reconstruction of the affected neural placode. Its specific mission is to tackle two main issues surrounding the management of complex dysraphic lipomas : whether total resection confers better long term benefits than partial resection, and whether total resection does better than conservative treatment, i.e., no surgery, for asymptomatic lipomas. Accordingly, the 24 years progression-free survival data of the author and colleagues' series of over 350 cases of total resection are compared with historical data from multiple series (including our own) of partial resection, and total resection data specifically for asymptomatic lesions are compared with the two known series of non-surgical treatment of equivalent patients. These comparisons amply support the author's recommendation of total resection for most complex lipomas, with or without symptoms. The notable exception is the asymptomatic chaotic lipoma, whose peculiar anatomical relationship with the neural tissue defies even our aggressive surgical approach, and consequently projects worse results (admittedly of small number of cases) than for the other two lipoma subtypes of dorsal and transitional lesions. Prophylactic resection of asymptomatic chaotic lipomas is therefore not currently endorsed.

• Journal of Chest Surgery
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• v.25 no.10
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• pp.1087-1092
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• 1992

We underwent two surgical resection of synchronous primary esophageal squamous cell carcinoma and gastric adenocarcinoma after obtaining histologic comfirmation 74-years old male pateint was recieved esophagectomy & total gastrectomy with esophagojejunostomy and 59-years old man was recieved near total esophagectomy and total gastrectomy with esophagocolo-gejunostomy. Their was no postoperative complications. The hospital day was 15 and 21 days postoperatively. All of them started oral intake at 7 days postoperatively and possible soft diet soon. We conclude that total resection of esophagus and stomach is the recommendable methods for prolong the life of double primary cancer patients of esophagus and stomach. Also, the reconstruction of the esophagus with colon or jejunal transposition is one of the recommenable procedure for curative surgical resection of double primary cancer in esophagus and stomach. And we also wish to emphasize the importance of detailed preopertive gastric examination for detect of gastric lesion and of careful intraoperative inspection of the gastric mucosa in patients with esophageal cancer whose preoperative gastric examination provide inconclusive evidence due to the severe esophageal stenosis.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.46 no.6
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• pp.373-378
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• 2020

The purpose of this review is to assess the surgical outcomes of two different treatment modalities, endoscopic and open resection, for the management of sinonasal malignancies by comparing the effectiveness of these two methods. A wide search was carried out considering various electronic databases for English language articles from 2013 to 2018 using keywords such as sinonasal malignancies, endoscopic surgery, open resection for sinonasal malignancies, and endoscopic versus open surgery. One thousand articles were identified from the literature for screening. After a thorough systematic assessment and based on the selection criteria, 10 articles with 4,642 patients were included in this quantitative analysis. With a total of 4,642 patients, 1,730 patients were operated on using endoscopic resection and 2,912 patients were operated on using open resection. The endoscopic approach was found to have a shorter hospital stay compared to open surgical resection (P<0.05). The rate of positive margins and the recurrence rate for open surgical resection were both smaller compared to those for endoscopic resection (P>0.05), and the endoscopic approach had smaller complication rates and a higher survival rate compared to open resection (P>0.05). Though endoscopic resection and open surgical resection have comparable postoperative benefits, preoperative evaluation of cases presenting with sinonasal malignancies is necessary for determining the right treatment method to obtain the best possible results postoperatively.

• Journal of Chest Surgery
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• v.54 no.5
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• pp.338-341
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• 2021

As diagnoses of small ground glass nodule (GGN)-type lung adenocarcinoma are increasing due to the increasing frequency of computed tomography (CT) screening, surgical treatment for GGN-type lung adenocarcinoma has rapidly become more common. However, the appropriate surgical extent for these lesions remains unclear; therefore, several retrospective studies have been published and prospectively randomized controlled trials are being undertaken. This article takes a closer look at each clinical study. Convincing evidence must be published on 2 issues for sublobar resection to be accepted as a standard surgical option for GGN lung adenocarcinoma. In the absence of such evidence, it is better to perform lobar resection as long as the patient has sufficient lung function. The first issue is the definition of a sufficient resection margin, and the second is whether lymph node metastasis is conclusively ruled out before surgery. An additional issue is the need for an accurate calculation of the total size and solid size on CT. Given the results of clinical studies so far, wedge resection or segmentectomy shows a good prognosis for GGNs with a total size of 2 cm or less. Therefore, sublobar resection will play a key role even in patients who can tolerate lobectomy.

• Journal of Korean Neurosurgical Society
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• v.56 no.3
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• pp.248-253
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• 2014

Objective : Cortical dysplasia (CD) is one of the common causes of epilepsy surgery. However, surgical outcome still remains poor, especially with frontal lobe epilepsy (FLE), despite the advancement of neuroimaging techniques and expansion of surgical indications. The aim of this study was to focus on surgical strategies in terms of extent of resection to improve surgical outcome in the cases of FLE with CD. Methods : A total of 11 patients of FLE were selected among 67 patients who were proven pathologically as CD, out of a total of 726 epilepsy surgery series since 1992. This study categorized surgical groups into three according to the extent of resection : 1) focal corticectomy, 2) regional corticectomy, and 3) partial functional lobectomy, based on the preoperative evaluation, in particular, ictal scalp EEG onset and/or intracranial recordings, and the lesions in high-resolution MRI. Surgical outcome was assessed following Engel's classification system. Results : Focal corticectomy was performed in 5 patients and regional corticectomy in another set of 5 patients. Only 1 patient underwent partial functional lobectomy. Types I and II CD were detected with the same frequency (45.45% each) and postoperative outcome was fully satisfactory (91%). Conclusion : The strategy of epilepsy surgery is to focus on the different characteristics of each individual, considering the extent of real resection, which is based on the focal ictal onset consistent with neuroimaging, especially in the practical point of view of neurosurgery.

• Korean Journal of Bronchoesophagology
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• v.3 no.1
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• pp.61-69
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• 1997

A total of 55 patients underwent surgical managements for postintubation tracheal stenosis from July 1975 through March 1997. All but 8 had received ventilatory assistance. The patients had S cuff lesions, 17 stoma lesions, 7 at both levels, 5 at subglottic lesions. Thirty two patients underwent the sleeve tracheal resection and end-to-end anastomosis. Five patients performed a wedge resection and end-to-end anastomosis. Twenty two patients received the Montgomery T-tube for relief of airway obstruction. Simple excision of granulation tissue was done in 7 patients. Rethi procedures(anterior division of cricoid cartilage, partial wedge resection of lower thyroid cartilage and T-tube molding) were performed in 2 subglottic stenosis patients. And the other subglottic patient was received permanent tracheal fenestration at 1975. The tracheoesophageal fistula patient was done sleeve tracheal resection and end-to-end anastomosis with interrupted double layer closure of esophageal fistula site. Cervical approach was used in 49 cases, cervicomediastinal in 13 cases and median stemotomy In 6 cases. Techniques for obtaining tension-free anastomosis included a cervical neck flexion(15-30$^{\circ}$) in all sleeve resection patients and laryngeal release in one. The length of resection was 1.5 to 5.0 on A total of 41 patients(74.5%) had good(24 patients) or satisfactory(17 patients) results. But in ten cases, the restenosis of anastomosis site which is the most common complication was developed Two of them underwent a second reconstruction and 8 patients required T-tube insertion for airway maintenance. Three patients(5.4%) died. The causes of death were tracheo-innominate artery fistula(2) and sudden obstruction of airway(1).

• Journal of Korean Neurosurgical Society
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• v.42 no.4
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• pp.276-280
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• 2007

Objective : The purpose of this study was to review the characteristics of falcine meningioma retrospectively and to identify the parameters associated with tumor recurrence. Methods : The analysis included; age, sex, extent of resection, and radiologic and pathologic findings. Falcine meningiomas were classified by location as anterior, middle, or posterior as described for parasagittal meningiomas. Results : Of the 795 meningioma patients treated between 1990 and 2004 at the authors' institution, 68 patients with meningiomas arising from the falx underwent craniotomies. There were 22 male and 46 female patients (1:2.1). Mean age was 55 years and ranged from 14 to 77 years. Locations of falcine meningioma were; the anterior third in 33 cases, middle in 20, and posterior in 15. Mean tumor volume was 42 cc and ranged from 4 to 140 cc. In 58 of the 68 patients tumors were totally removed. Additional surgery for recurrence was performed in 6 patients over 15 years. Of these 6 patients, only two patients underwent gross total tumor resection at first operation; the other four underwent subtotal tumor resection. Based on pathologic reports, the largest tumor subtype was transitional. There were four patients with a high grade tumor-three atypical and one anaplastic meningioma. Of the 68 patients, 59 achieved a good outcome (no neurological deficit or recurrence), six had temporary complications, two suffered new permanent postoperative deficits, and the remaining one died due to severe brain swelling despite postoperative intensive care. Extent of surgical resection was found to be significantly related to tumor recurrence. Conclusion : Falcine meningioma accounted for 8.5% of intracranial meningiomas and the transitional meningioma was the most common subtype of falcine meningioma. Gross total resection of tumor was the single most important predictor of an improved surgical outcome.

• Journal of Chest Surgery
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• v.16 no.3
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• pp.356-361
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• 1983

Pulmonary tuberculosis is still one of unsolved problems in Korea due to increased number of far-advanced and drug-resistant patients, who have poor pulmonary function. We have analyzed 1332 operated Gases during the period of 1958-1981. Annual incidence of the disease decreased from 110 [1960] to 21 [1980]. The ratio between male and female was 7:3 and the age of peak incidence was in the 3rd and 4th decades. Recently, patients below the age of 20 years were slightly decreased, but above 50 years were slightly increased. The patients consisted of far-advanced case in 60% and moderately-advanced in 39% in 1980, as compared with 40% and 59% correspondingly in 1965. Preoperative sputum positively decreased from 91% [1958-1963] to 43.8% [ 1974-1981 ]. Medically treated patients for more than 3 years increased from 16% [1958-1963] to 51% [1974-1981]. From the view of surgical indication, totally destroyed hung increased from 27% [1958-1963] to 4396 [1974-1981 ]. Therefore, pneumonectomy occupied 53.8% of total surgical management recently. Mode of surgical treatment showed that thoracoplasty [33%], resection [57%] in 1958-1963 and thoracoplasty [2%], resection [98%] in 1974-1981. As Semb`s thoracoplasty was the first choice of treatment until 1960, thereafter resection became the choice. Postoperative mortality increased from 1.6-2.096 to 396 recently as well as morbidity. It was mainly due to increased number of poor pulmonary function and postoperative spread of disease. On the basis of our experience, far-advanced and drug-resistant patients increased in number recently, whose pulmonary function was poor. So postoperative mortality and morbidity increased. Proper surgical intervention should be considered before the appearance of resistance for all chemotherapeutic drugs.

• Journal of Korean Neurosurgical Society
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• v.37 no.3
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• pp.193-196
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• 2005

Objective: Strategies for managing supratentorial primitive neuroectodermal tumors(PNETs) in children include surgical resection, craniospinal irradiation and chemotherapy. This study is performed in order to compare the efficacy of various methods of treatment and to describe its optimal management. Methods: We have reviewed all medical records and pathology slides of six children(four males and two females) with supratentorial PNET from November, 1987 to May, 2003. The extent of resection was confirmed by computed tomography and magnetic resonance studies. Results: The patients were aged 1 to 13 years and treated postoperatively with/without adjuvant therapy. Tumor location included was four cortical, one gangliobasal, and one pineal region. The presenting symptoms and signs consisted of increased intracranial pressure and focal neurological deficits such as seizure and hemiparesis. The treatment consisted of surgical resection alone in one patient, postoperative radiotherapy in one patient, postoperative chemotherapy in one, and postoperative radiotherapy with chemotherapy in three. Five patients lived more than 12 months after diagnosis and one patient among them has been living more than 5 years after diagnosis. Conclusion: We can improve the survival and prognosis of supratentorial PNET patients by radical gross total resection of tumor followed by craniospinal irradiation and aggressive chemotherapy. First of all, gross total resection of tumor is the most important among many factors.

• Journal of Korean Neurosurgical Society
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• v.29 no.11
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• pp.1445-1450
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• 2000

Objectives : The Objective of this study was to analyze the prognostic factors affecting survival in the patients with glioblastomas. Methods : We retrospectively studied 55 consecutive patients with glioblastomas who were admitted to neurosurgery department from January 1988 to March 1998. Fifteen pateients were excluded from the analysis because of follow-up loss and surgical motality. There were 24 male and 16 female patients, with a mean age of 51 years. Surgery consisted of biopsy in 4(10.0%) patients, subtotal resection in 9(22.5%) patients and gross total resection in 27(67.5%) patients. Nine(22.5%) patients received second operation. Twenty-eight(70%) received postoperative radiation therapy. Various levels of radiation dose were used, 6,000 rad over 7 weeks in most cases. The variable factors were examined for their relationship with survival ; age at the time of diagnosis, gender, duration of neurological symptoms, preoperative neurological state(Karnofsky performance score), extent of surgical resection, location of tumor, reoperation, and postoperative radiotherapy and chemotherapy. Result : The mean survival time was 55 weeks, three(7.5%) of the 40 patients survived more than two years. Survival time with biopsy only cases was 24 weeks, for those with subtotal resection 43 weeks, and for those with gross total resection 67 weeks. A mean survival time from the time of reoperation was 42 weeks. Statistically significant survival factors in glioblastoma were extent of surgical resection, postoperative radiotherapy and reoperation. Summary : Results of our series support the views that the extent of surgery, reoperation and postoperative radiation are important prognostic factors. We also recommend radical tumor removal, postoperative radiotherapy and reoperation, if possible.